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HomeMy WebLinkAboutBuilding Permit # 9/7/2016 3=0yG,N74Rr BUILDING PEFl: T 1. N6�fwrQ . 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION . n a. Permit No##: Date Received �S-T "us Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no no MAP PARCEL: ZONING DISTRICT:-Historic DShop village yes no TYPE OF IMPROVEMENT PROPOSED USE Non_ Residential Residential ❑ New Building i rbne family ❑ Addition ❑Two or more family ❑ Industrial Alteration No, of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ­;h W6 F r� YsY ell �� !� ❑ 1-1�Qdla� Y' ❑-V.�V ella £i$�n°'�rr;>`~;,.,.,. ssr � '9' „z`Gw•`.F''ia ��"..��" a ��* +:�'2.:°`^°r�`S ., � E.�` '.m� r�N,„.,��r`"c�' ,3F.-„'���'i"� ✓^�r � -c,.,,. r�.e�.MT,.?�r��r '�.^s...:.,... .,r i❑�Ilrraterl5ewerw_��� DESCRIPTION OF WORK TO BE PERFORMED: o . Identification- Please Type or Print Clearly OWNER: Name: G- Phone,, Address: Contractor Name. eq'L,,- - Phone: " _ Email: Address: Supervisor's Construction License: , a� _Exp. Date: 1 117 Home Improvement License: Exp. Date- jz ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ 4:�>b� Check No.: 5�2_ Receipt No.: 3o NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t%ORT11 q own of6a10 :� qr ndover 12 No. h ver, Mass O ..,.'e ? 7 CO !5?1066.r Lu� CMIC.12—tcR 4�. S � BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT . .... ........................ BUILDING INSPECTOR has permission to erect .......................... buildings an ..,�........ . ...i�!�1......�.. ..�,�r.�............... Foundation p ........ ct.., `j. . i . l lS.. . .. . � ., Rough to be occupied as ...�� ..., � .. Chimney provided that the person acce in this permit shall in e respect con orm to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST Ti® T Rough Service ......... Final BUILDING I ECTOR GAS INSPECTOR ®ccupaner Permit Required t® ®ccupV Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Contract to repair or replace Contractor: Owner: Job Location Blaine A. Scribner Andrew Parsons Glen Johnson 385 Sutton St. 59 Salem St. North Andover, Ma. 01845 North andover, Ma. 01949 978-265-8188 Contractor agrees to furnish labor, materials, and equipment necessary to complete the following work under industry standards and tolerances, generally described as: Replace the siding on the home including the_following: 1 . Remove all siding, trim soffits and rake boards and dispose of material. 2. Install cedar cla boardfs and shingles, P.V.C. trim fascia rakes 3. Replace soffits one piece P.V.0 vented material 4. Provide a dumpster for debris Not included 1 . Paintina 2. Cost of electrician if needed 2. Repair of any rotten wood which will be done on a per hour basis. Contractor has supplied the owner with a copy of his construction supervisors license, HIC license and liability insurance. Fixed Price: $35,800.00 paid as follows: 113 down payment........................$12,000.00 113 upon delivery of material........$12,000.00 Balance upon completion.............$11 ,800.00 Work will commence within one week upon signing of the contract and will take no longer than three weeks to complete, weather permitting. Date 1-/ a Signature of contractor Signature of Owner/ Rep You may cancel this transaction at any time prior to mid night of the third business day. Acceptance: I/we agree to these terms, acknowledge receipt of a signed copy of the contract and confirm work has not started before signing, and authorize the contractor to proceede. Date: / I ,.4 by- h,a�� ignature of Owner u 3 The Commonwealth ofMassqkusefts .E Department ofindustrialAceldents _ =F 1 Congress Street,,Suite 100 - —:` Boston,HA 02.1. 4.2017 , -: www.m=.govtdia Wo..t7lcexs'CompOnsatloninsurance A- idavlt.)3uUders/ConfractOrslEZectylcians/Pl m-bers. TO 33E FMEO VVf TH T1371 PER•IY=T' TG AUTIUORI:SY APPILant 110T.Matio • Pleaso print Ledb Name, (susiness/Organizationlfdividnal):^ �J�d=1►/S e— Ad&oss: J city/state/zip:—— Phane#: Areyou an employer?Cl?eekflie appropriaie box: Type of project(required): I.❑I am a employerWtb enapIoyces(pill and/orpart time)* 7. Q NOW cozistXticfiozi 2.L]I an.a solo propdetox or pai tnarship and have no employees rvozlcing f mein 8. El Renta dclidg any capacity.END workers'comp.insurance required.] �. ❑Demolitka 3.E]IaMKhOm,ownez doing all wank myself[No workers'comp..insurance required.]' 1 Q FJ Building addition 4.FJI am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contracfors either have workers'compensation inmramo or are sole 11.LI Electrical rap airs or additions pr"Hators,with no employees. 12:Q Plumbing Top airs or additions 5: I a general contcaotoranl Ihavelaired the sub-contractors listed On the attached sheet 13: Rooxepairs These sub-coatractorshave e�pleyees andhavcworkers'camp_insurance. 14.El Other 6.❑We are a cazporatzon grid ifs ofcers have exercised their right of exomptiorf perMGl C, 152,§1(4),andvrshave oqe� Io ees.[Noworkers'comp.insurance required.] *Any applicant that checks box#lI must also fill out the section below showing theirworkers'compensation policy intbzmatieri. s gomwho sixli 141k affidavit indicafingthey are doing all work and then outside contractors mist submit a new affidavit indicating such ,owners Coniracfors that checi�this boxmust atfac�kte an additional sheet showing the mina of the sab-contractors and state whether orpot those entities have r - employees, ifthe sub-can�raotors Bays employees,rlicy uzusE prosidetheir workers'camp.policy-U.umbm" aa°n an employer tlzatispxovidifzg-pporkers'compensado insurancefo;^Yny employees:'.Below is'thepalicy ayidjob site information. Insurance Company Name: Policy#or Self-ins.fic.#: Expiration Date: ab Site Address: J J� City/state/Zip: ICJ Attach a copy o�Fthcv�roxkexs' comp� satian policy declaration page(showing the polzsynumber and expiration.date). Failure to sectare cop olatiou punishable by a ane up to$1,500-00arage as required under MGL c_ x52, §25A is a criminal vx and/ox one year irnprisonrnent,as Well as civil penalties in the form of a STOPWORK ORDER and a tine of up to�2S©_00 a day against the violator.A copy of this statement may be horwarded to the Office of Investigations of the Dr4 for insurance coverage vorificatiou.. I do hereby certify urzc2er tree peens arzcipenaities ofperjxzry tlzai the infarytzaiion provided alcove is rue and correct Si awe: Date: a u Phone#: r Official rrse only. Do nollprite in this area,to be completed by city or torvrz official City or Town: Perbaft/License# fssuing Author#y-(circle one): i 1.)3oara[of eaith 2.BxtzldingDepar�aeAt 3.City/Town Clerk 4.Electrical Inspector 5.PlumbingTspecto3� 6.Other Co�ntact Person: fhoue#: DATE(MMMD1YM) A�" CERTIFICATE OF LIABILITY INSURANCE 8/17/I6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s, PRODUCER CONTACT ,NAME: Linnane M.P. Roberts Insurance Agency PHONE 978 683-8073 FAXNO; (378) 683-3147 1060 Osgood Street MAIL ADDRESS: kristin@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:American European Insurance Co INSURED . INSURER B i Merchants Mutual Insurance Co BAILEY CUSTOM HOMES INSURER C:Associated Employers Insurance BLAINE SCRI13NER INSURER D 385 SUTTON STREET INSURER!=: NORTH ANDOVER, MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. fNSR AWL SUER POLICY EFF POLICY EXP LIMBS LTR TYPEOFINSURANCE POUCYNUMBER MIDDN MMR7RIYYYY A GENERAL LIABILITY CPP120069010 1/27/16 1/27/17 EACHOCCURRENCE $ 1,000,000 }( COMMERCIALGENTO R ERAL LIABILITY DAMAGE ENTED $ 100,000 CLAIMS-MADE [A]OCCUR MED EXP one ersm) $ 5,000 PERSONAL&ADV INJURY $ 1 000 000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPLIES PER PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY PRO- LOC $ * AUTOMOBILE LIABILITY MCA7015253 10/27/15 10/27/16 C(E0 d nt)INGLEUMrr $ 1000 000 ANYAUTO BODILY INJURY(Per pe icon) $ ALLOWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS x AUTOS NDN-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS eraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LU18 CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION IN 10/17/15 10/17/16 WG STATU- OTH- C WCC-500-5013965-20I AND EMPLOYERS'LIABILITY AWPROPRIETORIPARTNERJEXECIJTIVE Y"" NtA E.L.EACHAC(7DEtJC 500.000 OFFICE WMEMBE..R EXCLUDED? _j (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 500,000 fi yyes,describe under DE SCRIPTIONOFOPERATIONSbalow E.L.DISEASE-POLICY LIMIT 500,000 DESCRIPTIONOFOPERATIONSILOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,ifmom spaceisraqured) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET SUITE 2043 NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE MICHAEL P ROBERTS O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORO name and logo are registered marks of ACORD Phone; Fax: E-Mail: _per OIs 10:JG ��,� PAYE(NA91kClYV'YYi CERTIFICATE OF LIABILITY INSURANCE _ 0#D117l21}15 THIS CERTIFICATE IS ISSUHD AS A MATTE-R OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CiIRTIFiCATE HOLDER- THIS CERTIFICATE DOE$ NOT AFFIRMATIVELY OR NE=GATIVI'LY AMEND, EXTEND OR At-TER THE COVERAGE AFFORUEU BY THE POLICIES UELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON$TITUIE A CONTRACT RETtIVf9EN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR P ROtIUC£Rr ANO THE CERTIFICATE HOLDER. IMPORTANT.- If the ror#ifitsto hold or is an AUL]ITiONAL INSURED,thO p811Gy(ie3) must be endoraad, if suDROGATION I$WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A-statement on tlyie Gertsficate doc5 not Confer rights to the certificate holder in lieu of such sndoraement(s)._ CONTACT — Sapreve&Hall ins ur.Assoc.inc - 305 Borth Main 8t, ° `---- Andover,MA 01910 AnDRr ss; Lawrence J.Hall PRi7saG>tr PARS-01 _ WSUREfi. .(9I A («QfigMG GQV(«RR�F iJAIC k -- � -- --- `--- 41360 IHBUR90 I4r1Ui`iIP S,I�r�r6*r1 —•-----a INSURCRA:Arbolla Protection 1ns.Co...._„�_ _ DSA Persons Construction IN$uREa e s A.I.M.MutLJgi Iris.CmO_-- 38758 334 Ferry Road USURERc: — _— . --..--- Ward Hill,MA 01836 IN URERD: COVERAGES CERTIFICATE NUMBER. -- —_ REVISION NUMBER. THIS!S TO CER7WY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN ISSUED TO THE INSURED NAMED ABOVE FOR THT TO pE1THIS INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRP;CT OR OTHER €DOCUMENT WITH RE$PEC'r TO WHICH THIS CERTIFICATE MAY FJE 15SUF_D OR MAY PERTAIN. THE !NSURANCE AFrORDFD aY THE POLICIE:u DE$CR!HEV HEREIN IS SUBJE=CT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS DF SUCH POLICIES.LIMITS SHOWN MAY HAVE Or-EN REDLIcED BY PAIL!CLAIMS. -- L1DY EFF `XPLTR LJMITti _ TYPE OF INSURANCE _—..P f4 MUM MM/ DrFM InIMN—wIVW QUNGRALLIAaIU'FV _ EACHOCCURRENCE __m A :GQmNEAClALEiFNERALLIABILITY PREI41I81 P- 0,001 10 GLWMS-hiA4E I pCCLR MkDExP( ar Parson) S _$sWUtT F45263+746376 1 12MI12015 12/0112016 PERSOM&-S ADV INJURY 5 ry 1,400,00 GENERAL AGGREGATE 2,000,00 — PFkDi1L1CT9-GohWrGP AGG s 2,000,00 GEN'L.AL3(.3RE)ATE.41MIT APPLIES PER. PR CI• & w POLICY LOC _ .— ._ �.._ ..�...-_._ . ACI3'A1AL1al4re LIABILITY — ggMfiiNEO SINGLE LIMtT 9 (Ea acddar4) _ A ANY AUTO Fjo200014iV 02110046 02/1612017iL�11€JURYjRetpvn�l 3 _ ALi,OWNED AUTOS I BODILY JWA)LV IPaa 0.4ddrnl)1 X SCHEOULEDAUT08 x 1 (FERAGGTIWNT) HIRED AUTOS E 3 X NON-OWNMAUT08 — UML4JLELLA LIAR LSGOUR EACH OCCURRENCE Rs)4RFGATE 1 f 0(cr.gSL3A8 I 4,LA1IA9-PMA DEi ---_'T S OEpUCTTBLE — RE7@NTI4N ---- X lhl Y1ATLI — MIT COMPENSATION 76 y AHO EMPLOVEW UAR€LITY YINR.L.PACH ACCIDENT AW PROPriIETORIPARTUGRlZXECUTIVE �WC6006754 P1i7t1001010 GFFI(`,£ruMEN6r fKOLUPED? ED NJAI E.L,G1S£•ASE-EAEA3PLUY7=E 6 jMandat,nryto HH) 11 es tleacrit�urd� `E.L.DISFAJJE-pQ IGY LIMIT 6 r -- QEiyCA1FTIDN DF'OparW1lpN8!LOCATIQiVFi f YERICL.cB (AIt0.�'1t Af:QRIJ 361,Adcflll4naE ftlYia�Xa$g>ledule,Itmerr rpapa I4 rcquiretl) 88019 proprietor hall:not elected coverage under Workers Camp. CERTIF )�(}LDER �— CA CLLi ATIOIV ,-------- NpFtTHAN 814OULL3 ANY OF THE ABOVE DESCRIBED P4LlCIE9 BE GRNCI`.LLED 13EF35rtE TH£ EXPIRATION DATE THERHOF, NOTICE WELL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POL-ICY FROVIs,Otttl. Main utmet North Andover,MA 04 8$9 AUTHORIZED REPRESENTATIVE 18$6-200 ACORD CORPORATIN•Ali rights reserycd. ACORD 26(2009109) The ACORD name grid logo are regislured marks of ACORD •-"' _ DYY)CERTIFICATE OF LIABILITY INSURANCE 0812212016 _ THIS CERTIFICAYE 18 €SSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHY'$ UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AmEN1], ExTI=NO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS (%RTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT., If the ceff ficdte holder i5 an ADDITIONAL INSURED, the policy((eu)must be ondor50d. If SUBROGATION I3 WAIVEU,subject to the terms and Ganditions of tho poHoy,certain polloip13 may regclire an endorsement, A staUrnorm on this oertificate does not Confer rigtlta to the aertiflcate holder in lieu of such endomeinent(ss) � PRODUCU --- 'ONTkCY qr se rl;Yu&HaiIInsur.Assoc.lnc PHONE 306 North Main tit, � Andover,MA 91510 G-MAILADZn Michael L.3agravePROW— PARS-01 T re Ind - lt SURE.ff 6 AFFT]RDING C:fJaRAG£ MAIC N IN#FU �o Arsdrlrw�. BrgUn� INBVRERAJArbella Proteotion Ins.Co. 41360 _ DSA Parsons COnst19,1Gtlon INSURERA:A,I,M.Mutual Ina.Co. � �- — T� 33768 334 Forty Road -- m-- Ward Hill,MA,VI63 a --- sNeuaRtF n; COVERAGES� CERTIFICATE NUMBER, REVISION AIi1IwaIOgfk: THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN 155UF0 T:? —THE—INSURED NAMED ABOVE FDR TH.:POLICY PERIOD INDICATED, 40-rWiTHSTANDING ANY REQUIREMENT, TERM OR GONDITfON OF ANY CopjTRA r OR OTHER DOCUMENT WTH RESPECT TO W+11GH THIS CERTIFICATE MAY BE ISSUED 4R NAY PEaTAIN, THE INSURANCE ArrORDED BY THE POLICIES DEaGRISED HEREIN IS 3130JCCT TO ALL THE'TERMS, EXCLUSIONS AND CONDITIONS OF SUC1?POLICIES,LIMITS SHOWN Mk(HAVE BEEN REOIJO cD BY PAID CLAIMS. IWSRI TYPE OF INSi11iANCL• PQ�10Y RUM9ER fFQL' YYY II'`fi k�ir!]u^IYYYY LIMITS �_ OrNE-P{At.LIABILRY -- EACH iJCCiIRRENCE. $te— Y, 11000,00 A X 001AMERCIALGENERALLIAI311,IYY I r < ms EaPa0u7[m2 S 100,00 CLAII IS.iAAD6 1 A OCCUf4 t.IF.fS III{Any Ona P01&oT) $ 6,00 - -----�I 952004A3Y0 1210117tl15 17J911Z015 PUP404,�L e-ADV INJURY f 9,000,90 0ENEW\L AGGREGATE 3 2,000,00 COT!,AGGkEGATE LIMIT APPI_)Eti PER: rHODU079•t;{1rr7PfOP AGG 3 210901119 POLICY PRD- LOC — AUT4MOINLG LIABILITY — COMB€HrD$14,14 GLI1LIMIT {&a aec�daotl 6 AANY AUTO 9 020901 412✓S I) I1612016 0$11512497 I 5001LY INJURY(Pdf 11S i ALL OWNED AUTOS rBpi71LYINJURY(Pm;acedani) S P� i8CREDULEOAUTOS PROPERTYDAMAnE S rM�-- X HIRED A rr4B I (PER ACCIDENT) x�NQN-p1'vN#iL)AVT4l6 I - 3 UMBRELLALua OCCUR — � EACHOCCURKNCE 8 — E)4CE33 UAB 1 _ OLA1MS-MADE I AGeK-GATE DEDUCTIBLE�� $ _� ~ T6NTi0N WGR!(ERa 0(jMrF14FO 9ATN -....���1 -----.--'-•Y� i ...Tx �1M STATLI DTH- AND EMPLOYMIS'LIA91LNY V 1 lMIT R _ $ Y 1 N -wy PRGP'EYIETQRIPAFITN0P1Vx5CQrVr 05005754 105134120181 06110!2017�E,(<EACH 4C41DENY 5 109,0 OF'FK:EI7 EMSSER O(CLUDED? Y N 1 a (Ma"wary In NMI �'" 1 E t.pF�EASE-II EVIPl.0YE $ ...—_.._ 100,001 If ,ds++y'ihi vnd9! C L.DISEASE•POLIGY LIMIT 3 W�. 500,00, RIPTJIPSZt'cRfAT a' ---�.— — i i 99tRIPTION OF OP111RA710114B 1 LOCA1001 V4HtQL6j0 (AtINch ACORD 191,Addltidnal RamaAb Schedule,If Mom apncc 6 requlmd( Sole Proprietor has not elected coverage tinder Workers Comp. SHOULD ANY pF THE XROVP DESCk.l13E[I II BE CANCIII LEIS II THF EXPIRATION DATE 7+11 NOTICE WILL BE DELIVERED IN Glomi&Kathy Johnson ACCORDANCE WI711 Tft POLICY PROVISIt7N$, So Salem stmot Furth Andover,MA 01$45 .,. _..�.�....T . -- � _.y AUTHORIZED Rf?Pftl:R@NATIV@ k�)108E-2009 AC ORO CORPORATION, All rights resery®d. ACORD 25(2000100) The ACORD nesme and logo are:registered marks of ACORD LtOZl8tlli a';W;:ASE;.r,..a 9"W VW M3AOUNV HINON Ll 1S NOIIOS 9$£ H3NOIHOS V 3NIVIS £L9£91YS� :ra:su.u; �p�p spsiepuuej, pue st: )geltofuu bmpppng 10 p:jec: E 1a1,:1e, OyIWIl d W 4u0ku4Jvt10G 1.l asstup e s:e7d Office of t onswner Affairs&Business Regulation License or registration valid for individul use only 11 � IOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 174751 Type: Office of Consumer Affairs and Business Regulation a1 V1 Expiration: 31151`2017 Individual 10 Park Plaza-Suite 51.70 Roston,MA 02116 BLAINE A.SCRIBNER BLAINE SCRIBNER 365 SUTTON ST NO.ANDOVER,MA 01845 Undersecretary Not valid without signature _ ----—